Manager Revenue Integrity (Remote)

About the Role

This is a remote, full-time day-shift position providing leadership and day-to-day operational management for the local hospital(s) and/or Medical Group Provider Services (MGPS) revenue integrity functions. The role focuses on preventing revenue leakage, maximizing potential revenue, and optimizing staff performance through process redesign, policy implementation, and professional development.

Responsibilities

• Lead and motivate staff to achieve high performance in revenue integrity, working with key stakeholders.
• Manage Charge Description Master (CDM), pre-bill edits, root cause analysis, denials coordination, denial prevention, audits, and education/training for multi-disciplinary teams.
• Optimize revenue performance through process redesign, policy implementation, communications, and staff development.
• Collaborate with Revenue Integrity and Payer Strategies leadership to ensure understanding and application of payer contracts.
• Monitor Medicare, Medicaid, and other payer websites for changes impacting charging, coding, and billing; ensure compliance and revenue optimization.
• Coordinate denials resolution with Patient Business Service (PBS) and identify root causes of denials.
• Perform root cause analysis on denials and pre-bill edits; collaborate with teams to implement process improvements.
• Prepare and conduct educational services for departments and staff on audit findings, regulatory changes, coding updates, and billing requirements.
• Develop colleague work schedules to ensure cost-effective staffing and meet customer requirements.
• Manage team projects, foster collaborative relationships, and promote active participation across departments.
• Assess developmental needs of the department and provide opportunities for professional growth.
• Hire employees, allocate resources, conduct performance appraisals, and provide ongoing feedback.
• Analyze and display data in meaningful formats; develop policies, procedures, and management reports, including Key Performance Indicators.
• Maintain knowledge of applicable federal, state, and local laws, as well as Trinity Health’s compliance programs and policies.
• Perform other duties as assigned.

Requirements

• Bachelor’s degree in Finance, Business Administration, or a related field.
• Minimum of 5–7 years of progressively responsible experience in revenue cycle operations, including revenue integrity.
• Minimum of 3 years of management experience in a multi-facility, integrated healthcare delivery system or revenue cycle consulting.
• Experience in revenue integrity for acute care and/or physician practices.
• Strong understanding of appeals, denial management, medical necessity, and coding audits.
• Ability to read medical charts and correlate services to charges on UB and 1500 claim forms.
• Knowledge of Diagnosis Related Group (DRG), Ambulatory Payment Classification (APC), Outpatient Prospective Payment System (OPPS), and pre-bill edits (e.g., OCE/CCI edits, DNFB).
• Experience with Charge Description Master (CDM) maintenance or oversight preferred.
• Ability to organize, plan, and manage staff in revenue integrity activities for large healthcare organizations.
• Knowledge of laws and payer contracts governing hospital and physician billing.
• Demonstrated ability to work effectively with diverse groups, including physicians, clinicians, administrators, and third-party payers.
• Strong analytical skills, including data collection, analysis, and report preparation.

Qualifications

• Licensure/Certification: RHIA, RHIT, CCS, CPC/COC, or other coding credentials preferred.
• CDC (Healthcare Compliance Certification) preferred.

Pay

Salary Range: $42.2592–$63.3888 per hour.

Physical and Mental Requirements

• Operates in a typical office environment (well-lit, temperature-controlled, hazard-free).
• Frequent communication (in-person and phone) with teams across locations.
• Manual dexterity required for keyboard use; hearing necessary for extensive communication.
• Ability to concentrate, meet deadlines, and manage multiple projects in a fast-paced, interrupt-driven environment.
• Must adapt to changing priorities and workloads, including extended or varied hours.
• Ability to thrive in a multi-customer environment with conflicting needs and diverse personalities.